Female Breast Cancer Incidence Research Articles

Trends in incidence and mortality of female breast cancer during transition in Central China.

PurposeFollowing the implementation of breast cancer (BC) control strategies for years in Central China, the outcome needs to be evaluated and further strategies based on long-term surveillance should be formulated. Therefore, we examined the trends of BC incidence and mortality during 1990–2014 and projected them to 2024 in Wuhan, Central China.Patients and methodsThe incidence and mortality data of BC were extracted from the Wuhan Cancer Registry. The average annual percentage changes (AAPCs) of the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) were analyzed using Joinpoint regression. The Nordpred R-package was used to project BC incidence and mortality between 2015 and 2024. The age–period–cohort analysis was applied to evaluate the age, period, and cohort effects on the trends of BC incidence and mortality.ResultsOverall, the ASIR increased markedly from 20.01 to 44.26 per 100,000 (AAPC=3.3%, 95% CI: 1.7%, 5.0%) during 1990–2014, and it was projected to keep increasing in the next decade (AAPC=3.0%, 95% CI: 2.0%, 4.1%). The ASMR of BC leveled off during the study period (AAPC=0.4%, 95% CI: −0.2%, 0.9%). The BC mortality of the older group (aged 50–79 years) showed significant upward trends in both observed and projected periods. Strong age, period, and cohort effects were observed in BC incidence, and BC mortality was significantly driven by age and cohort effects.ConclusionThe ASIR in Wuhan was approaching those areas with the highest BC risk in China, and the evident increase in BC incidence suggested that prior strategies for BC control should be adopted. In particular, further strategies for reducing BC mortality in older age groups should be reinforced in Wuhan, Central China.

Evaluating Neighborhood Correlates and Geospatial Distribution of Breast, Cervical, and Colorectal Cancer Incidence.

Introduction: Though cancer research has traditionally centered on individual-level exposures, there is growing interest in the geography of both cancer and its risk factors. This geographic and epidemiological research has consistently shown that cancer outcomes and their known causal exposures exhibit geographic variation that coincide with area-level socioeconomic status and the composition of neighborhoods. A retrospective study was conducted to evaluate geospatial variation for female breast, cervical, and colorectal cancer incidence in Baltimore City.Materials and Methods: Using a Maryland Cancer Registry dataset of incident breast, cervical, and colorectal cancers (N = 4,966) among Baltimore City female residents diagnosed from 2000 to 2010, spatial and epidemiological analyses were conducted through choropleth maps, spatial cluster identification, and local Moran's I. Ordinary least squares regression models identified characteristics associated with the geospatial clusters.Results: Each cancer type exhibited geographic variation across Baltimore City with the neighborhoods showing high incidence differing by cancer type. Specifically, breast cancer had significant low incidence in downtown Baltimore while cervical cancer had high incidence. The neighborhood covariates associated with the geographic variation also differed by cancer type while local Moran's I identified discordant clusters.Discussion: Cancer incidence varied geographically by cancer type within a single city (county). Small area estimates are needed to detect local patterns of disease when developing health and preventative programs. Given the observed variability of community-level characteristics associated with each cancer type incidence, local information is essential for developing place-, social-, and outcome-specific interventions.

DDT exposure in early childhood and female breast cancer: Evidence from an ecological study in Taiwan

Researchers still lack consensus on the association between exposure to DDT and the risk of breast cancer. One reason could be that the measurements of DDT obtained during or near the time of diagnosis may not reflect exposure during the etiologically relevant time period in a woman's life. This study undertook an ecological analysis to investigate whether exposure to DDT among cohort born between 1951 and 1959 (i.e. age 0–5 years) and who reached the age 50–54 years during 2001–2013 had an increased risk of breast cancer in adulthood. To do this, we used the number of DDT sprays in each township during the anti-malaria campaign in Taiwan in the 1950s as a proxy for direct DDT exposure. The DDT sprays were then linked to the township female breast cancer incidence rate in the 2000s when the birth cohorts had reached age 50–54 years. Insurance claims data were used to identify breast cancer cases during 1996–2013. Zero-Inflated Poisson regression was performed to estimate the effect of DDT sprays on the breast cancer incidence rate. The analysis was based on a total of 9 birth cohorts (1951–1959) in 349 townships who had lived at least up to age 50. On average, one DDT spray experienced during age 0–5 years was associated with an increase of 8 more female breast cancer cases per 100,000 during age 50–54. The effect appears to increase with the number of sprays. Our finding suggests that DDT exposure in early childhood could raise the risk of breast cancer in adulthood.

Epidemiology of Female Breast Cancer in West Jakarta, Indonesia

Background: Breast cancer was the most common cancer in the world. GLOBOCAN 2012 estimated the incidence of female breast cancer in Indonesia was 40.3 per 100,000 and the mortality rate was 16.6 per 100,000. In 2016, Dharmais National Cancer Center was appointed as Regional Population Based Cancer Registry in West Jakarta. West Jakarta was a municipality with 2,281,945 populations, being the 2nd largest population in DKI Jakarta Province. Aim: This study was to evaluate the quality of population based cancer registry data and to describe the epidemiology of female breast cancer in West Jakarta, Indonesia during 2008-2012 and to compare with GLOBOCAN 2012 . Methods: We used population based cancer registry data with ICD - O code C50.0-C50.9 in female who live in West Jakarta. The population based cancer registry data were collected in Dharmais National Cancer Center. We evaluated the quality of population based cancer registry data based on WHO-IARC rules for cancer registry data. Results: The quality of population based cancer registry data were microscopic verification (70%); DCO percentage (20.8%), and unknown age (0%). The trend of female breast cancer was increasing during 2008-2012. Age-standardized rate incidence was 19.3 per 100,000. The most of frequent were in 45-49 years old, not other specific location subtopography (81.5%), the histopathology type was ductal and lobular neoplasm (51.8%), in stage III (44%), and with metastases to bone (34%). The average of length of duration was 29.1 months, most of them were unknown of last status contact (84%). Conclusion: The coverage and quality data of West Jakarta population based cancer registry need to be increased and establish a follow-up system to decrease the unknown last contact status of patients.

Cancer Incidence and Mortality Among Ethnic German Migrants From the Former Soviet Union.

Germany is a country known for immigration. In 2015, 21% of the general population in Germany consisted of individuals with a migration background. This article focuses on cancer-specific incidence and mortality among one of the biggest migrant groups in Germany: the resettlers. Resettlers are ethnic Germans who mainly immigrated from the Russian federation and other countries of the former Soviet Union after its collapse in 1989. We investigated differences between resettlers and the general German population, regarding (i) incidence and mortality of malignant neoplasms, (ii) time trends of the corresponding incidence and mortality, and (iii) cancer stage at diagnosis. We provide data from two resettler cohorts covering an observation time of 20 years: one cohort on cancer incidence (N = 32,972), and another cohort on mortality (N = 59,390). Cancer-specific standardized incidence ratios (SIR) and standardized mortality ratios (SMR) for all malignant neoplasms combined and the most common cancer-sites were calculated between resettlers and the general German population. Time trend analyses using Poisson regression were performed to investigate the developments of SIRs and SMRs. To investigate differences in stage at diagnosis, logistic regression was performed, calculating Odds Ratios for condensed cancer stages. We observed higher incidence and mortality of stomach cancer [SIR (men) 1.62, 95%CI 1.17–2.19; SMR (men) 1.62, 95%CI 1.31–2.01; SIR (women) 1.32, 95%CI 0.86–1.94; SMR (women) 1.52, 95%CI 1.19–1.93] and higher mortality of lung cancer [SMR (men) 1.34, 95%CI 1.20–1.50] among resettlers compared to the general German population, but lower incidence and mortality of colorectal (both sexes), lung (women), prostate and female breast cancer. However, time trend analyses showed converging incidence risks of cause-specific incidence over time, whereas differences of mortality did not show changes over time. Results from logistic regression suggest that resettler men were more often diagnosed with advanced cancer stages compared to the Münster population. Our findings suggest that risk factor patterns of the most common cancer-sites among resettlers are similar to those observed within the Russian population. Such increases in prostate, colorectal and breast cancer incidence may be the consequence of improved detection measures, and/or the adaptation of resettlers to the German lifestyle.

Primary and Preventive Care of Women

Women’s health can be defined as diseases or conditions that are unique to women or that involve gender differences that are particularly important to women. This definition acknowledges the increasing scientific evidence supporting a focus on sex and gender and expands the concept of women’s health beyond the traditional focus on reproductive organs and their function. Over time, the definition has come to include an appreciation of wellness and prevention, the interdisciplinary and holistic nature of women’s health, the diversity of women and their health needs over the life span, and the central role of women as patients and as active participants in their health care. This broader interdisciplinary perspective has important implications for clinicians providing care to women. In addition to understanding basic female physiology and reproductive biology, clinicians need to appreciate the complex interaction between the environment and the biology and psychosocial development of women. When dealing with conditions that are not specific to women, clinicians need to be aware of those aspects of disease that are different in women or have important gender implications. The ability to apply this information requires that clinicians adopt attitudes and behavior that are culturally and gender sensitive. Figures visualize female life expectancy, age-adjusted death rates, female breast cancer incidence and death rates, trends in female cigarette smoking, and the U.S. Preventive Services Task Force guidelines for preventive primary care in women. This chapter contains 5 highly rendered figures, 52 references, 5 MCQs, and 1 teaching slide set.

Socioeconomic status and breast cancer in Lithuania

Introduction In Lithuania, breast cancer (BC) is the most common non-cutaneous cancer and the most common cancer death among women. The aim of this study was to determine the influence of SES on female BC incidence, mortality and survival during the period 2001–2009, using population-based census-linked registry data covering the entire population of Lithuania. Methods The study was based on a census-linked dataset which is based on the linkage of all cancer cases from the Lithuanian Cancer Registry (cancer incidence) and all deaths and emigration records from the Statistics Lithuania for the period 6 April 2001–31 December 2009 to the 2001 population census records at the beginning of the follow-up period (6 April 2001). Emigration records were needed in order to estimate population exposures under risk. The population under study included all of the permanent residents of Lithuania aged 30–74 years on the census day (6 April 2001). Information about urban-rural place of residence and education was taken from census records. Education was classified according to three broad categories of completed education: higher education (at least 14 years of schooling), secondary education (10–13 years of schooling), and lower than secondary education (up to 9 years of schooling). Incidence rate ratios (IRR) and mortality rate ratios (MRR) by education and urban-rural residence were estimated by means of multivariate Poisson regression models controlling for age and using higher education and urban place of residence as reference categories using higher education and urban as a reference category. In order to calculate relative survival rates, life tables for the general population by each educational category and each place of residence were calculated using the same census-linked dataset (cumulative five-year survival rates for the period 2001–2009 were estimated). The expected survival estimates were derived using the Ederer II method. STATA statistical software was used to calculate relative survival and avoidable deaths. Results IRRs showed substantial and statistically significant inverse effects of education and place of residence. The lowest risk of BC was observed in the group of women with lower than secondary education (0.63 times, CI: 0.59–0.67) and in rural areas (0.77 times, CI: 0.73–0.80). Statistically significant lower risk was also observed in the secondary education group (0.80 times, CI: 0.76–0.84), as compared to the higher education. Mortality rates ratios also showed a statistically significant inverse educational mortality gradient. The lowest MRRs were in women with lower than secondary education (0.87 times, CI: 0.79–0.96). There were no significant differences in MRRs by place of residence. We found the same inverse gradient in BC survival, with the worst survival indicators in the lower than secondary education group. Survival rates were significantly decreasing with decreasing education. Five-year relative survival in the higher education group was 80.2%. The absolute difference in survival rates between the highest and the lowest educational groups was 15.3%. The study found a moderate disadvantage in survival among rural women. The same gradient was observed by place of residence too. Conclusions The higher risk of BC in the highest SES in Lithuania corresponds to the results from other countries. For BC, the risk gradient may be explained by other well-established breast cancer risk factors such as postponement of childbearing and low parity which are also more common among females with high SES in Lithuania. Higher SES women are also more likely to obtain routine mammography screening due to better access to preventive healthcare, thereby increasing the detection of breast cancer in this group. SES differences in access to healthcare, modern treatment, as well as inequalities in time of diagnosis may explain the observed differences in BC survival.

Incidence trend and change in the age distribution of female breast cancer in cancer registration areas of China from 2000 to 2014

Objective: To estimate the incidence trend and change in the age distribution of female breast cancer in cancer registry areas in China from 2000 to 2014. Methods: 22 cancer registries in China with continuous monitoring data from 2000 to 2014 were selected. All datasets were checked and evaluated based on data quality control criteria and were included in the analysis. The cancer registries covered 675 954 193 person-years, including 342 010 930 person-years of male and 333 943 263 person-years of female. Female breast cancer cases (International Classification of Diseases-10(th) Revision: C50) were extracted. Crude incidence rate (CR), age-standardized incidence rate by Chinese standard population(ASIRC), annual percent change (APC), crude and adjusted mean age at onset were calculated. Incidence rates stratified by regions and age groups were calculated. Results: Female breast cancer incidence rate significantly increased from 31.90/100 000 in 2000 to 63.30/100 000 in 2014. Incidence rate increased rapidly from 2000 to 2008 (CR: APC=6.5%, 95%CI: 5.3%-7.8%; ASIRC: APC=4.6%, 95%CI: 3.6%-5.7%). Its increment slowed down from 2008-2014 (CR: APC=3.2%, 95%CI: 1.4%-5.1%; ASIRC: APC=1.4%, 95%CI:-0.1%-2.9%). The crude mean age at onset increased from 54.4 in 2000 to 57.0 in 2014. Adjusted mean age at onset remained around 54.3 in 2014. Crude mean age at onset increased significantly over time in all registry areas (β=0.192, P<0.001), urban (β=0.205, P<0.001) and rural (β=0.092, P=0.014) areas, while adjusted mean age at onset remained stable in all registry areas (β=0.009, P=0.289), urban (β=0.017, P=0.139) and rural (β=-0.054, P=0.109) areas. Conclusion: Female breast cancer incidence rate in China increased from 2000 to 2014. Aging of the population resulted in a significant increase in crude mean age at onset. After age adjustment, no significant changes in age distribution were found.

Ambient air emissions of polycyclic aromatic hydrocarbons and female breast cancer incidence in US.

To examine ambient air pollutants, specifically polycyclic aromatic hydrocarbons (PAHs), as a factor in the geographic variation of breast cancer incidence seen in the US, we conducted an ecological study involving counties throughout the US to examine breast cancer incidence in relation to PAH emissions in ambient air. Age-adjusted incidence rates of female breast cancer from the surveillance, epidemiology, and end results (SEER) program of the US National Cancer Institute were collected and analyzed using SEER*Stat 8.3.2. PAH emissions data were obtained from the Environmental Protection Agency. Linear regression analysis was performed using SPSS 23 software for Windows to analyze the association between PAH emissions and breast cancer incidence, adjusting for potential confounders. Age-adjusted incidence rates of female breast cancer were found being significantly higher in more industrialized metropolitan SEER regions over the years of 1973-2013 as compared to less industrialized regions. After adjusting for sex, race, education, socioeconomic status, obesity, and smoking prevalence, PAH emission density was found to be significantly associated with female breast cancer incidence, with the adjusted β of 0.424 (95% CI 0.278, 0.570; p < 0.0001) for emissions from all sources and of 0.552 (95% CI 0.278, 0.826; p < 0.0001) for emissions from traffic source. This study suggests that PAH exposure from ambient air could play a role in the increased breast cancer risk among women living in urban areas of the US. Further research could provide insight into breast cancer etiology and prevention.

Incidence trends and patterns of breast cancer in Sri Lanka: an analysis of the national cancer database

BackgroundA gradual decline in the incidence of breast cancer is documented in developed countries especially over last two decades, while in developing countries the incidence continues to rise. We conducted this study to examine trends in incidence of breast cancer in a developing country, Sri Lanka.MethodsA retrospective cohort evaluation of patients with breast cancer during 2001–2010 was performed using population based data from the Sri Lanka National Cancer Registry. Trends in incidence were analysed using Joinpoint regression analysis.ResultsThe age standardized incidence of female breast cancer in Sri Lanka appears to have increased from 17.3 per 100,000 in 2001 (95% confidence interval [95% CI] 16.5–18.2) to 24.7 per 100,000 in 2010 (95% CI 23.7–25.7); a 1.4-fold increase (p < 0.05) with an estimated annual percentage change (EAPC) of 4.4 (95% CI 3.3–5.5). Highest incidence of breast cancer was seen among women of 60 to 64-year age group which has increased from 68.1 to 100.2 per 100,000 over this period (EAPC 4.6%, 95% CI 3.9–5.2, p < 0.001 for trend). A substantially greater increase was observed among women older than 50 years (from 50.4 to 76.9 per 100,000; EAPC 5.5, 95% CI 4.1–7.0, p < 0.05) compared with women younger than 50 years (from 32.0 to 39.6 per 100,000; EAPC 2.3, 95% CI 1.1–3.5, p < 0.05).ConclusionsA gradual but a significant increase in the incidence of female breast cancer is observed in Sri Lanka. A rapid rise in the breast cancer incidence among post-menopausal women appears to be the major contributor towards this increase. Improving cancer data collection appears to have been a contributor to the observed increase. However, an inherent increase is also likely as differential rates of increase were observed by age groups. Further research is needed to identify the reasons for the observed increase which may help with future cancer control efforts in Sri Lanka.

Incidence and mortality of female breast cancer in China, 2014

Objective: To estimate the incidence and mortality of female breast cancer in China based on the cancer registration data in 2014, collected by the National Central Cancer Registry (NCCR), and to provide support data for breast cancer prevention and control in China. Methods: There were 449 cancer registries submitting female breast cancer incidence and deaths data occurred in 2014 to NCCR. After evaluating the data quality, 339 registries' data were accepted for analysis and stratified by areas (urban/rural) and age group. Combined with data on national population in 2014, the nationwide incidence and mortality of female breast cancer were estimated. Chinese population census in 2000 and Segi's population were used for age-standardized incidence/mortality rates. Results: Qualified 339 cancer registries covered a total of 288 243 347 populations (144 061 915 in urban and 144 181 432 in rural areas) in 2014. The morphology verified cases (MV%) accounted for 87.42% and 0.59% of incident cases were identified through death certifications only (DCO%), with mortality to incidence ratio of 0.24. The estimates of new breast cancer cases were about 278 900 in China in 2014, accounting for 16.51% of all new cases in female. The crude incidence rate, age-standardized rate of incidence by Chinese standard population (ASRIC), and age-standardized rate of incidence by world standard population (ASRIW) of breast cancer were 41.82/100 000, 30.69/100 000, and 28.77/100 000, respectively, with a cumulative incidence rate (0-74 age years old) of 3.12%. The crude incidence rates and ASRIC in urban areas were 49.94 per 100 000 and 34.85 per 100 000, respectively, whereas those were 31.72 per 100 000 and 24.89 per 100 000 in rural areas. The estimates of breast cancer deaths were about 66 000 in China in 2014, accounting for 7.82% of all the cancer-related deaths in female. The crude mortality rate, age-standardized rate of mortality by Chinese standard population(ASRMC) and age-standardized rate of mortality by world standard population (ASRMW) of breast cancer were 9.90/100 000, 6.53/100 000, and 6.35/100 000, respectively, with a cumulative mortality rate of 0.69%. The crude mortality rates and ASRMC in urban areas were 11.48 per 100 000 and 7.04 per 100 000, respectively, whereas those were 7.93 per 100 000 and 5.79 per 100 000 in rural areas. The incidence and mortality rates of breast cancer were higher in areas than those in rural areas. The age-specific incidence rates of breast cancer increased greatly after 20 years old and peaked at the age group of 55-60. The age-specific mortality rates increased rapidly with age, particularly after 25 years old. They remained at a relative stable level from 55 to 65 years of age, and then increased dramatically and peaked in the age group of 85 and above. Conclusions: Breast cancer is still one of the most common malignant tumor threatening to famale health in China. The disease is more prevalent in urban areas at the age group of 55-60. Comprehensive prevention and control strategies referring to local status and age groups should be carried out to reduce the burden of breast cancer.

Number concentrations of ultrafine particles and the incidence of postmenopausal breast cancer

Background: There have been a number of reports regarding possible associations between the incidence of female breast cancer and ambient air pollution. Only one study has been published about possible association with ultrafine particles (UFPs; &lt;0.1 μm). Methods: We conducted a case–control study of incident postmenopausal breast cancer in Montreal, Canada. Cases were identified between 1996 and 1997 from all hospitals that treated breast cancer. Controls were women diagnosed with other sites of cancer and frequency-matched to cases by hospital and 5-year age groups. Concentrations of UFPs were estimated using a land-use regression model developed in 2011–2012 and assigned to women’s residential addresses at time of diagnosis. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using logistic regression models adjusting for individual-level and ecological covariates. Results: We found that the response functions between UFPs and incident, postmenopausal breast cancer were consistent with linearity. Adjusted ORs of 1.08 (95% CI = 0.96, 1.21) were found for an increase in UFPs equal to the interquartile range (IQR). We found higher ORs among cases with positive estrogen (ER+) and negative progesterone receptor (PR−) (OR = 1.23; 95% CI = 1.04–1.45) and for women with ER−/PR− status (OR = 1.23; 95% CI = 0.99–1.54). We also found stronger associations when analyses were restricted to those women who had not lived at their current address for 10 years or more (OR = 1.27; 95% CI = 0.94–1.71). Conclusions: Our findings suggest that exposure to ambient UFPs may increase the risk of incident postmenopausal breast cancer, especially among cases with ER+/PR− and ER−/PR− receptor status.

Estimates of cancer burden in Emilia-Romagna.

This paper aims to provide a comprehensive overview of mid-term epidemiological trends for the major cancer sites in the Emilia-Romagna region of northern Italy (population 4,400,000). The MIAMOD method, a back-calculation approach to estimate and project the incidence of chronic diseases from mortality and patient survival, was used for the estimation of incidence and prevalence by calendar year (from 1970 to 2015) and age (from 0 to 99). Survival estimates were taken from cancer registries of northeastern Italy. The estimated incidence of stomach cancer decreased by approximately 75% for both sexes. Trends in incidence of colorectal cancer differed between males and females. For females, the rate increased moderately until the year 2000 with a slow decrease thereafter, whereas the male colorectal cancer incidence showed a regular increase until 2010 followed by a substantial leveling off. Among males the lung cancer incidence and mortality rates showed a steep increase until the late 1980s and a rapid decrease thereafter. Among females, the trends were increasing over the entire study period. The estimated incidence of female breast cancer rose sharply between 1970 and 2001, but from that year onwards a slightly decreasing trend was observed. Mortality peaked in 1988 and has fallen since. The incidence of prostate cancer showed a 3-fold increase. After 2005, the rate is expected to stabilize. Among females, the estimated prevalence increased for breast cancer (52,700 cases expected in 2015), colorectal cancer, lung cancer and melanoma, while decreasing for stomach cancer and cervical cancer. Among males, the estimates showed an upward trend for prostate cancer (32,100 cases expected in 2015) and colorectal cancer, and a leveling off for lung cancer after 2010. The estimates were fairly consistent with previous data from several epidemiological sources. The MIAMOD method provided a picture of the impressive increase in the prevalence of breast cancer and prostate cancer over the 45-year period studied.

Decreasing Birth Rate Determining Worldwide Incidence and Regional Variation of Female Breast Cancer

Purpose: Urbanization, obesity and ageing associated with lifestyle changes (Westernized diet patterns, pollution, physical inactivity) have been proposed as the major contributing factors for the global rise in breast cancer (BCa) and have been the variables used to predict the future breast cancer rate. At the same time, socio-economic level, instead of birth rate, has been proposed for explanation of dramatic regional variations of breast cancer incidence. We sought to determine which factor plays the determining role in predicting worldwide breast cancer incidence rates and regional variations. Methods: Bivariate correlation was conducted to examine the relationships between country-specific estimates of birth rate, BCa incidence, urbanization, overweight, ageing and GDP. Partial correlation was performed to identify the correlation between BCa incidence with each independent variable while we controlled the other four variables. Multiple linear regression was used to identify the most significant predictors of BCa incidence. Post hoc Scheff and independent T-Test analysis were performed to compare mean differences in BCa incidence rates and residuals of BCa standardised on birth rate in the WHO regions, and UN developed and developing regions respectively. Results: Worldwide, BCa incidence rate tends to increase while birth rate decreases and urbanization, overweight, ageing and GDP increase. However, birth rate was the only variable that had a significant correlation with BCa incidence when controlled for the other four variables. Birth rate was the only significant predictor of BCa incidence in regression analysis. Multiple mean differences of BCa incidence between regions were significant, but all disappeared when the contributing effect of birth rate on BCa incidence rate was removed. Conclusions: Birth rate plays a determining role in worldwide BCa incidence rate and regional variations. Current BCa projection methods may estimate future rates of BCa poorly if they fail to incorporate the impact of birth rate.

Estimated and Interactively Visualized Female Breast Cancer Incidence Rates in Missouri Senate Districts: 2008-2012.

ObjectivesTo measure and interactively visualize female breast cancer (FBC) incidence rates in Missouri by age, race, stage and grade, and senate district of residence at diagnosis from 2008 to 2012.MethodsAn observational epidemiological study. The FBC cases in counties split by senate districts were geocoded. Population database was created. A database was created within SEER*Stat. The incidence rates and the 95% Confidence Interval (CI) were age standardized using US 2000 Standard Population. The Census Bureau’s Cartographic Boundary Files were used to create maps showing Missouri senate districts. Incidence results were loaded along with the maps into InstantAtlas™ software to produce interactive reports.ResultsCancer profiles were created for all 34 Missouri senate districts. An area profile and a double map that included interactive maps, graphs, and tables for the 34 Missouri senate districts were built.ConclusionThe results may provide an estimation of social inequality within the state and could provide clues about the impact of level of coverage and accessibility to screening and health care services on disease prevention and early diagnosis.

Urban rural disparity in female breast cancer incidence rate in China and the increasing trend in parallel with socioeconomic development and urbanization in a rural setting.

BackgroundWorldwide breast cancer incidence correlates with socioeconomic status and increases in parallel with westernization, however urban–rural disparity and trends have not been adequately investigated in China.MethodsThe age standardized rate (ASR) of female breast cancer by population‐based cancer registration was compared between urban Shijiazhuang city and rural Shexian County in relation to socioeconomic status. The increasing trend of breast cancer in Shexian County from 2000–2015 was examined using Joinpoint analysis and the correlation with gross domestic product (GDP) per capita was analyzed.ResultsIn 2012, the ASR of female breast cancer in Shijiazhuang was more than three times higher than in Shexian County (45.5/1 00 000 vs.13.8/1 00 000; P < 0.01) when the GDP per capita was 2.6 times higher (US$6964.80 vs. US$2700). In parallel with rapid socioeconomic development and urbanization, the biennial ASR of female breast cancer in Shexian county has increased significantly from 2.8/1 00 000 in 2000–2001 to 17.3/1 00 000 in 2014–2015, with an average biennial percent change of +10.2% (P < 0.01). The Pearson correlation between ASR and GDP was significantly positive (r = 0.94, P < 0.01).ConclusionThe incidence of breast cancer in women in China is increasing along with lifestyle westernization and changing reproductive patterns associated with socioeconomic development and urbanization. Urgent prevention measures, including the development of a healthy diet, giving birth at a younger age, an increase in breastfeeding, limiting menopause estrogen therapy, and control of alcohol consumption, are required.

Analysis of the patterns of female breast cancer incidence in Shanghai, 2003-2012

Objective: To analyze the patterns of female breast cancer and their incidence in Shanghai during 2003-2012, and to compare them with international data. Methods: The data of female breast cancer cases diagnosed between 2003 and 2012 were collected from the Shanghai Cancer Registry. The record of cancer cases included the patient's name, gender, date of birth, permanent and residential address, diagnosis site or name, histological type, date of first diagnosis, diagnostic basis and diagnostic stage, etc. Data source of cancer incidence of World, Developed Countries, Developing Countries, East Asia and China in 2012 sourced from GLOBOCAN 2012 database of the WHO International Agency for Research on Cancer (IARC); and the data of USA during 2008-2012 was collected from SEER 18 database from Surveillance, Epidemiology, and End Results Program of the National Cancer Institute (NCI). Incidence indicators of Shanghai female breast cancer were calculated, including the average cases, median age, average age, proportion, crude rate, age-specific rate and age-standardized rate. Results: During 2003-2012, 41 991 new cases of female breast cancer were diagnosed in Shanghai, with an average of 4 199 cases per year, accounting for 17.23% among total new female cancer cases, ranking first in female cancer incidence in Shanghai during 2003-2012, with a crude incidence rate of 60.90 per 100 000 and an age-standardized incidence rate of 33.90 per 100 000. During 2008-2012, an average 4 528 new cases of female breast cancer was diagnosed per year in Shanghai, with 16.97% among total female cancer cases. The median age was 56 years old and the mean age was 57.73 years old. The crude rate was 64.23 per 100 000 and the age-standardized rate was 35.00 per 100 0000, which was higher than those of China (22.1 per 100 000), Eastern Areas (27.0 per 100 000) and Developing Counties (31.3 per 100 000), and lower than that of World (43.1 per 100 000), and Yellow Race Population of USA (68.77 per 100 000). During 2003-2007, on average, 3 869 new cases of female breast cancer were diagnosed per year in Shanghai, accounting for 17.54% of total female cancer cases. The median age was 53 years old and the mean age was 56.44 years old. The crude rate was 57.42 per 100 000 and the age-standardized rate was 32.69 per 100 000. There was a continuing peak stage spanned 25 years old from 50 to 74 years old, during 2008-2012. Compared with those of 2003-2007, the beginning age group of the continuing peak stage was delayed for 5 years old and the ending age group was delayed for 10 years old. Conclusion: The age-standardized incidence rate in Shanghai was higher than those of China, Eastern Areas and Developing Counties, and lower than that of World, and that of Yellow Race Population of USA; Compared with 2003-2007, the crude rate and age-standardized rate increased, the median age, mean age and the beginning and ending age group of the continuing peak stage were delayed.

Geographic variations in female breast cancer incidence in relation to ambient air emissions of polycyclic aromatic hydrocarbons.

A significant geographic variation of breast cancer incidence exists, with incidence rates being much higher in industrialized regions. The objective of the current study was to assess the role of environmental factors such as exposure to ambient air pollution, specifically carcinogenic polycyclic aromatic hydrocarbons (PAHs) that may be playing in the geographic variations in breast cancer incidence. Female breast cancer incidence and ambient air emissions of PAHs were examined in the northeastern and southeastern regions of the USA by analyzing data from the Surveillance, Epidemiology, and End Results (SEER) Program and the State Cancer Profiles of the National Cancer Institute and from the Environmental Protection Agency. Linear regression analysis was conducted to evaluate the association between PAH emissions and breast cancer incidence in unadjusted and adjusted models. Significantly higher age-adjusted incidence rates of female breast cancer were seen in northeastern SEER regions, when compared to southeastern regions, during the years of 2000-2012. After adjusting for potential confounders, emission densities of total PAHs and four carcinogenic individual PAHs (benzo[a]pyrene, dibenz[a,h]anthracene, naphthalene, and benzo[b]fluoranthene) showed a significantly positive association with annual incidence rates of breast cancer, with a β of 0.85 (p=0.004), 58.37 (p=0.010), 628.56 (p=0.002), 0.44 (p=0.041), and 77.68 (p=0.002), respectively, among the northeastern and southeastern states. This study suggests a potential relationship between ambient air emissions of carcinogenic PAHs and geographic variations of female breast cancer incidence in the northeastern and southeastern US. Further investigations are needed to explore these interactions and elucidate the role of PAHs in regional variations of breast cancer incidence.

Comparison of annual percentage change in breast cancer incidence rate between Taiwan and the United States-A smoothed Lexis diagram approach.

Recent studies compared the age effects and birth cohort effects on female invasive breast cancer (FIBC) incidence in Asian populations with those in the US white population. They were based on age–period–cohort model extrapolation and estimated annual percentage change (EAPC) in the age‐standardized incidence rates (ASR). It is of interest to examine these results based on cohort‐specific annual percentage change in rate (APCR) by age and without age–period–cohort model extrapolation. FIBC data (1991–2010) were obtained from the Taiwan Cancer Registry and the U.S. SEER 9 registries. APCR based on smoothed Lexis diagrams were constructed to study the age, period, and cohort effects on FIBC incidence. The patterns of age‐specific rates by birth cohort are similar between Taiwan and the US. Given any age‐at‐diagnosis group, cohort‐specific rates increased overtime in Taiwan but not in the US; cohort‐specific APCR by age decreased with birth year in both Taiwan and the US but was always positive and large in Taiwan. Given a diagnosis year, APCR decreased as birth year increased in Taiwan but not in the US. In Taiwan, the proportion of APCR attributable to cohort effect was substantial and that due to case ascertainment was becoming smaller. Although our study shows that incidence rates of FIBC have increased rapidly in Taiwan, thereby confirming previous results, the rate of increase over time is slowing. Continued monitoring of APCR and further investigation of the cause of the APCR decrease in Taiwan are warranted.

Light Alcohol Drinking and Risk of Cancer: A Meta-Analysis of Cohort Studies.

PurposeThe purpose of this study was to determine whether light alcohol drinking increases the risk of cancer by using a meta-analysis of cohort studies because the newly revised 2015 European Code against Cancer fourth edition on alcohol and cancer was based on critical flaws in the interpretation and citation of the previous meta-analyses.Materials and MethodsPubMed and EMBASE were searched in April, 2016. Two authors independently reviewed and selected cohort studies on the association between very light (≤ 0.5 drink/day), light (≤ 1 drink/day), or moderate drinking (1-2 drinks/day) and the risk of cancer incidence and mortality. A pooled relative riskwith its 95% confidence intervalwas calculated by a random-effects meta-analysis. Main outcome measures were cancer incidence and mortality.ResultsA total of 60 cohort studies from 135 articles were included in the final analysis. Very light drinking or light drinking was not associated with the incidence of most cancers except for female breast cancer in women and male colorectal cancer. Conversely, light drinking was associated with a decreased incidence of both female and male lung cancer significantly and both female and male thyroid cancer marginally significantly. Moderate drinking significantly increased the incidence of male colorectal cancer and female breast cancer,whereas it decreased the incidence of both female and male hematologic malignancy.ConclusionWe found that very light or light alcohol drinking was not associated with the risk of most of the common cancers except for the mild increase in the incidence of breast cancer in women and colorectal cancer in men.